The long-range goal of this project is to reduce or overcome barriers to cancer-related symptom management among American Indians (AIs). Little is known about the phenomena of cancer-related symptoms, their management, and barriers to care, or about the barriers faced by AI patients needing and/or seeking symptom management. Such cancer-related symptoms as fatigue, depression, and pain experienced by this population require clearer understandings-in terms of definitions, cultural constructs of symptoms, decision-making strategies, barriers to care, provider referrals, and treatment for symptom management care. This is an innovative, interdisciplinary study to (a) clarify/define the cultural constructs of cancer-related symptoms, and (b) to develop and test a reproducible clinic-based, innovative, and culturally appropriate program to overcome barriers to care for AI symptom management. 1. To ascertain, through qualitative means, barriers to treatment and management that derive from AI cultural perspective. More specifically, this aims seeks: To gain an understanding of culturally-embedded meaning of cancer-related symptoms (pain, fatigue, depression), their conceptualization, cultural construct(s), patterns and strategies of their disclosure by AIs. To identify the pathways and mechanisms of communication and treatment-seeking that AIs use for management of cancer-related pain and symptoms. To identify symptom management decision-making strategies/barriers among AI cancer patients/providers. 2. To design culturally sensitive materials to be used in the intervention phase of the study. These tools will include educational and resource materials and culturally appropriate instruments for measuring symptoms intended to improve AI knowledge of and access to cancer symptom management services. 3. To develop and test a reproducible, clinic-based, culturally appropriate intervention designed to overcome barriers to the delivery of symptom management for AIs. This intervention will be cast in a Talking Circles format, a culturally meaningful vehicle that has proven effective in past studies.